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The Life-Changing Surgery No One Talks About

02/22/2016

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Hysterectomy is one of the most common yet least talked about surgical procedures in America. By age 60, one in three women will have had their uterus removed—most commonly done to relieve the pain of fibroids, but also as a treatment of endometriosis, heavy bleeding, pelvic pain, and some gynecological cancers. But even women who have had one aren’t always 100 percent sure about the details, says Sarah Colvin, MD, a gynecologist at Indiana University Health. Here, some of the facts you need to know:

1.There can be a mix of organs involved: “A hysterectomy is technically the removal of the uterus, and that’s it,” says Dr. Colvin. Most of the time it includes the cervix (the narrow, neck-like lower part of the uterus), but in some cases, depending on whether or not you’re at risk for cervical cancer and which method of surgery your doctor is using, he can just remove the top part of the uterus, leaving the cervix in place. If your fallopian tubes and/or ovaries are affected by endometriosis, however, or you’re at high risk for ovarian cancer, those organs may be removed as well during the surgery.

2.It doesn’t necessarily mean you’ll hit menopause: As long as you still have at least one working ovary, you can still produce estrogen and you won’t become menopausal until you hit the age your biological clock was originally set for. But if you also have your ovaries removed during surgery—as Angelina Jolie Pitt did recently—you will go into menopause immediately following surgery.

3.You won’t get your period anymore: Your monthly bleeding is a result of the uterus shedding its lining—if there’s no uterus, there’s no lining, and no period, even if you’re still ovulating, Dr. Colvin explains (though if you still have your ovaries, you may still experience moodiness and PMS during your cycle). Also, obviously, without a uterus you can no longer become pregnant.

4.Explore all of the options: In some cases, such as uterine cancer, hysterectomy may be the best answer. But if you have fibroids, endometriosis, or other health issues, there are several intermediate steps you can try first before agreeing to surgery, says Dr. Colvin. These include an IUD, birth control pills, or the non-hormonal drug Lysteda to relieve heavy menstrual bleeding;

5.Make an effort to understand the methods: Traditional hysterectomy is done through an incision in the abdomen, but the uterus can also be removed through the vagina, which means less scarring and a shorter recovery time (about two weeks, compared with six weeks for abdominal surgery). With laparoscope-assisted hysterectomy, which also has around a two-week recovery period, the surgeon inserts a small tube with a camera through a tiny incision in your abdomen and then removes the uterus in smaller pieces through the vagina or the small abdominal incision. The type of surgery you can get depends upon many factors, including the size of your uterus and fibroids; whether you’ve had previous abdominal surgery, including a C-section; whether your doctor needs to see the rest of your organs to check if endometriosis has spread; and the experience and training of your surgeon.

6.It may improve your sex life: Though many women fear that removal of the uterus will put a damper on their sex life, Dr. Colvin says the opposite is often true. “